Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. I aim to show how contemporary developmental science points us on a path to effective prevention, intervention, and treatment, with the aim of promoting healthy development and wellbeing of all children and families.

Friday, February 24, 2012

Colic and Migraines: A Complex Relationship

In a new study, neurologists at the University of California, San Francisco who surveyed new mothers at their pediatricians office found that mothers who suffer migraine headaches are more than twice as likely to have babies with colic than mothers without a history of migraines. Proposing a genetic link, they hypothesize that colic may represent an early form of migraine.

Before we can launch any meaningful conversation about colic, it is essential to recognize that when we talk about mothers and infants, we are talking about an intense passionate love relationship (see my previous post). When all goes well, the caregiver, who is usually the mother, is highly attuned to the needs of her infant, who in these early months is completely helpless. In a natural and healthy way that accompanies this state of falling in love, a mother is, to quote D. W.Winnicott,, "preoccupied" with her baby. They are engaged in a beautiful dance, in which the mother, by supporting and containing the baby, helps him to learn to regulate himself in the face of all the new experiences he has out in the busy, bright, loud world.

It is not as simple as "the mother has migraines, so maybe the baby has migraines." The exquisite dance of mutual regulation, that goes on naturally when both mother an baby are well, is severely disrupted. It is replaced by a dance of mutual dysregulation.

The baby may be more sensitive to sensory input, as the authors postulate. This difficulty with sensory processing is thought to be a significant component of colic, even if the mother does not have migraines. But the other person in the dance, far from being "preoccupied" with her baby, may be" lying prostrate on the couch for 10 hours," as one migraine sufferer wrote on her blog in response to this study. Certainly her ability to respond to her baby will be in some way impaired by her own distress. The crying, in turn, may worsen the migraine. This is not meant to be a judgment, but simply a fact.

The growing discipline of infant mental health looks at colic not only as a problem in the baby, who may have a variety of biological vulnerabilities, (sensitivity to sensory input being one of them) but as a problem in a relationship. For a new mother, who had anticipated this period as a time of bliss but is instead faced with baby who is either crying or sleeping, with few moments available for gazing adoringly into each others eyes , colic can be a devastating experience.

Recently I had the privilege of teaching about infant mental health to a group of psychologists and psychiatrists who work with very troubled adults, many of whom had significant disruptions in relationships starting in infancy. My students wanted to know what questions to ask when taking early developmental history. I found that they know what to ask, as in "did he have colic?" but they don't know what to listen for in the answers. I told them that my aim was to give texture to colic -to give them sense of what colic felt like, how it was experienced by both the baby and caregiver.

Interestingly this word "texture" came up again last week. I have been taking a wonderful online course on regulatory and sensory processing disorders taught by Rosemary White, who worked closely with the late Stanley Greenspan. White used the word "tailor" to describe how mothers are attuned to their babies, preferring this word to the word "calibrate" that she has used in previous courses. She said that the word "tailor" gives more "texture" to the experience.

There is yet another layer to the "texture" of colic. Mothers, even in the absence of migraines, may struggle with intense feelings of inadequacy in the face of a baby who cries all the time. Add to that chronic sleep deprivation along with an illness like migraines, and there may be a slide into depression.

Recognizing and exploring this "texture" of colic has significant implications for treatment. Rather than exclusively focusing on the baby, it is important to listen to the mother. A mother will need to know that another caregiver who she trusts, be it a spouse, close friend or relative, can watch the baby when she has a migraine. If she can count on such a person, it may lessen the guilt she will likely be experiencing. She may need to attend a group with other mothers facing similar challenges so that she does not feel so isolated. She may need to work on-on-one with an infant mental health specialist who can help the "couple' to manage the stresses on their relationship.

Even in the absence of colic, a mother needs to feel heard, valued and not alone in order to be free to provide that "primary maternal preoccupation." But when she is not well, and her infant is crying all the time, that kind of supportive environment is even more essential. When a mother has such a "holding environment," to again quote Winnicott, she is better able to provide that holding environment for her baby. Together they can make their way thorough these early months when the baby is totally dependent and helpless. It is important in those difficult months, to keep in mind that by "hanging in there," the time will come when a baby can reach for a toy, bring his thumb to his mouth, and begin to learn to comfort himself. This is a skill he will, with the help of his caregivers, continue to develop and refine as he grows increasingly more independent.

1 comment:

  1. Love your blog, Dr. Gold! We (Sensory Processing Disorder Foundation) are going to be having a conference close to you, and thought you may be interested in going...here is the info: http://www.spdfoundation.net/boston2012/
    Would also like to know if you have any interest in reviewing up to date resources on autism, Asperger's Syndrome and SPD? Let me know.

    With Gratitude for all you do!

    ~Marla Roth-Fisch
    award winning author/illustrator Sensitive Sam
    VP External Affairs Sensory Processing Disorder Foundation
    digital media marketing strategist, Future Horizons, Inc.